1. Field of the Invention
The present invention relates to a device and method to treat periodontal disease in felines, particularly in situations where the disease has progressed to advanced stages of periodontitis and feline lymphocytic-plasmacytic gingivitis (commonly referred to as feline lymphocytic-plasmacytic stomatitis).
2. Information Disclosure Statement
Oral diseases are especially prevalent in cats. Periodontal disease can range from a localized inflammation of the gingiva (gingivitis) to inflamation and destruction of the gingiva, alveolar bone, the periodontal ligament, and tooth structure (periodontitis). Etiology of the disease can involve plaque, calculus, and systemic inflammatory response.
Generally, the protocol for treating periodontal disease focuses on cleaning the oral cavity, repairing the tissue, and stopping the progression of the disease. However, the available treatment methods, which include scalping, polishing, curettage, dental extractions, root planing, gingivectomies and in extreme cases, gingival flaps or grafts, are inadequate when treating advanced periodontitis and feline lymphocytic-plasmacytic gingivitis/stomatitis.
Root planing is often necessary to remove necrotic tissue from the roots of periodontally involved teeth. A curette or Orban file is applied to the root surface and withdrawn in overlapping strokes using sufficient pressure to scrape necrotic cementum and debris from the root and smooth its surface. However, due to the anatomical structure of a cat's mouth, it is very difficult to remove the necrotic debris without affecting the surrounding soft tissue.
A gingivectomy is often performed to eliminate gingival sulcus, in an effort to facilitate plaque control and oral hygiene. A gingivectomy is required where pocket depths exceed 4 mm, the epithelial attachment is still above bone level, and resection can be contained within the attached gingiva. The level of epithelial attachment is determined using a periodontal probe and is marked on the buccal surface of the gingiva. The gingival tissue is then excised using a periodontal knife. Digital pressure is usually sufficient to effect hemostasis. However, the gingiva is especially narrow in cats therefore, it is very difficult to limit resection to the attached gingiva. Additionally, the anatomical structure of a feline's mouth limits the available working area and restricts maneuverability of instruments within the mouth thereby reducing the precision by which the procedure can be performed.
Cats exhibit particular manifestations of periodontal disease that are unique to the feline species. For example, a chronic problem in cats that is commonly associated with both chronic gingivitis/periodontitis and feline lymphocytic-plasmacytic stomatitis is external root resorption. Inflammatory resorption occurs at the cementoenamel junction. The presence of exuberant gingival tissue often conceals extensive cavitations in the tooth that undermine the crown eventually causing it to fracture and crumble thereby exposing the dentin. Exposed dentin is sensitive and extremely painful.
Typically, a fluoride gel is administered to treat this condition to desensitize the dentin. However, restoration has not been very successful and in many circumstances all of the teeth must be extracted. Extraction of involved teeth is often difficult because the crowns are weakened and therefore tend to fracture easily. Additionally, the roots are usually ankylosed and hard to separate from the surrounding bone. The long-term therapeutic response for treating external root resorption has typically been poor.
The cats are also placed on systemic antibiotics and long-term corticosteroids to reduce the risk of infection and to reduce inflammation. However, antibiotic treatments are usually not effective in treating feline lymphocytic-plasmacytic gingivitis/stomatitis because a primary bacterial causative agent has not yet been identified and long-term corticosteroid use can lead to serious secondary systemic side effects such as kidney failure.
Thus there is a need for a device and method that will improve treatment for cats with periodontal disease, particularly in the advanced stages of periodontitis and feline lymphocytic-plasmacytic stomatitis without the complications associated with the prior art.